Tramadol (Ultram) concentrations in death investigation and impaired driving cases and their significance

We reviewed a series of 66 deaths in Washington State between 1995-2000 in which tramadol (Ultram and Ultracet, Ortho-McNeil) was detected in the decedent's blood, in order to assess the role tramadol was determined to have played. Additionally, we reviewed a series of 83 impaired driving cases in which tramadol was detected in order to establish a non-lethal blood tramadol concentration reference range. In both populations, tramadol was consistently found together with other analgesic, muscle relaxant, and CNS depressant drugs. Death was rarely attributable to tramadol alone. However, tramadol may be a significant contributor to lethal intoxication when taken in excess with other drugs, via the potential interaction with serotonergic antidepressant medications, as well as the potential for increased CNS depression. Although the incidence of tramadol detection has increased consistently over the last eight years, there is no evidence of a corresponding increase in the number of cases in which death was attributed solely to tramadol. Blood drug concentrations in many deaths exceeded the therapeutic serum range of 0.28-0.61 mg/L; however, the concentrations overlapped almost completely with the range identified in living subjects arrested for impaired driving. These findings suggest caution in the interpretation of blood tramadol concentrations outside of the recognized therapeutic range. It also suggests that the drug, even when used in moderate excess, is not a principle cause of death in suicidal or accidental deaths.     

More than bricks and sticks: Five components of community development corporation capacity

Abstract

Community development researchers, practitioners, and funders have recently begun to emphasize the need for community development corporations (CDCs) to build capacity. However, the practice of using the term capacity without carefully defining it allows for a wide range of meanings to be assigned to the term and hinders efforts to study and measure it. Capacity is often defined narrowly in terms of housing production, oversimplifying a complex concept and process.

To remedy this shortcoming, we create a framework that views capacity more broadly by dividing it into five components: resource, organizational, programmatic, network, and political. We believe that this more concrete way of thinking about capacity will be particularly useful to practitioners, funders, and policy makers. We apply our definitions to CDCs, particularly those that work with local intermediaries called community development partnerships (CDPs), in order to better understand the role of CDPs in the process of building capacity.     

Breastfeeding Duration and Reported Child Maltreatment in a Population-based Alaskan Birth Cohort

Journal of Family Violence - Research suggests that breastfeeding may reduce child maltreatment risk. Alaska has high rates of both breastfeeding initiation and maltreatment reports to Child...